2. Homeostasis
Stress free perioperative
care helps in restoring
homeostasis following
elective Sx.
Resuscitation, surgical
intervention and critical
care can take back a
severely injured patient to
homeostatic state of the
body.
10/29/2022
2
A.N Malik
3. The graded nature of injury
The more severe the injury, the greater the
inflammatory response.
Elective surgery of intermediate severity
slightly raises the To, PR, RR, BMR and WBCc
thus in major Sx, these parameters will be
more accentuated to an extent that SIRS and
MODS may ensue.
10/29/2022
3
A.N Malik
4. The graded nature of injury
This evolution is as
well graded in terms
of time with the
initial response
being milder and
mediater by the
innate immune
system and later this
may end leading to
depressed immunity.
10/29/2022
4
A.N Malik
5. Mediators of metabolic response to
injury
10/29/2022
5
A.N Malik
SIRS mediated by
IL-1, IL-6 and TNFα
is shortlived.
It is followed by
increased plasma
levels of cytokine
antagonists and
soluble receptors (IL-
1Ra, TNF-sR). If
prolonged, leads to
counter inflammatory
response syndrom.
6. Hormonal mediators of the metabolic
response to injury
Acute phase:
beneficial
Chronic
phase:
deleterious
10/29/2022
6
A.N Malik
7. The ebb and flow model: phases of
physiological response to injury
10/29/2022
7
A.N Malik
Ebb phase (from time of
injury to 24-48hrs).
Characterised by ↓BP,
↓BMR, ↓CO, hypovolaemia
and lactic acidosis.
Mediated by
catecholamines, cortisol and
aldosterone. Attenuated with
proper resuscitation.
Follow this link to read and make notes on
metabolic response to injury:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379844
/
